Department of Social Work International Master of Science in Social Work SEXUALITY EDUCATION IN SWEDEN A study based on research and young people’s service providers in Gothenburg International Master of Science in Social Work Degree report 15 higher education credits Spring 2008 Author: Bonolo Kelefang Supervisor: Barbro Lennéer Axelson TABLE OF CONTENTS PAGE Abstract …………………………………………..…………………..…… …………1 Acknowledgements ………………………………………………………...................2 1. Introduction ………………………………………………..……………………….3 1.1Structure of the degree report ……………………………..……………...………..3 1.2 Choice of subject ……………………………………...……………….………….3 1.3 Aims and objectives of the study …………………………..………….………….3 1.4 Research questions …………………………………………………..……………3 2. Youth & Health – some facts……………………………………….…..…………..4 2.1 Youth sexual health and HIV/AIDS …………………….....…….………………..4 2.2 STIs and HIV scene in Sweden ……………………………………….……..……4 2.3 Provision of sexuality education in general ………………………………………5 2.4 Background of sexual & reproductive health in Sweden …..……………………..6 2.4.1 Sexuality education in Swedish schools ………………….…………….……….6 2.4.2 Youth clinics ……………………………………………………...……………. 7 2.4.3 Other sources ……………………………………………………………………8 3. Earlier research …………………………………………………………..…………9 4. Theoretical Framework ………………………………………..……….…………11 4.1 Definition of words ………………………………………..………….…………11 4.2 Social cognitive theory …………………………….…………………………….12 4.3 Empowerment ………………………………………………………….………..13 4.4 Prevention work ……………………………………………………………….. 13 5. Research Methods ………………………………….………………………….….15 5.1 Qualitative study …………………………………………………………….…..15 5.2 Sampling …………………………………………….…………………………..16 5.3 Method of analysis ………………………………………………………………16 5.4 Reliability & validity ……………………………………...……………………..17 5.5 Generalizability …………………………………………….……………………17 5.6 Ethical considerations …………………………………………………...………17 5.7 Limitations of the study …………………………………………………………18 6. Results and Analysis …………………………………..………………………….19 6.1 Goals of school and youth clinics with regards to sexual health ………...………19 6.2 How are information and education provided ……………………...…………....20 6.2.1 Group education ………………………………………………..……………20 6.2.2 Individual counselling …………………………………………….....………22 6.2.3 Condom campaigns and other activities …………………………..…..……..23 6.3 Methods employed for gender mainstreaming ……………………….………….23 6.4 Topics mostly discussed in sexuality education ………………......….………….25 6.5 Service providers’ experiences…………………………………………..……….27 6.5.1 anxiety disorder ………………………………………….…..………………27 6.5.2 changing of partners ………………………………………….……….……..27 6.5.3 non use of condoms ……………………………………………………….…28 6.5.4 skyrocketing incidences of STIs ……………………………………….…….29 6.5.5 Fall in frequency of HIV/AIDS campaigns ………………………...………..30 6.5.6 Other contributing factors ……………………………………..……….……31 6.6 Monitoring & Evaluation ……………………………………………...………...32 6.7 Future prospects …………………………………………………..……...……..33 7. Reflections and Conclusion ……………………………………....……………….34 8. Recommendations ……………………………………………………………..….37 References ……………………………………………………….…………………..39 Appendices …………………………………………………………………………..44 Appendix I - interview schedule Appendix II - letter of consent ABSTRACT The study was conducted in Sweden to reflect on the country’s adolescent sexuality education and the youth service providers’ experiences. Method: 5 interviews were held, 1 individual and 4 group interviews. Groups were made up of 3 people in two of the groups and 2 people in the other two groups. Data used was primary from (informants) and secondary (researches made in Sweden about the subject area). Results: Empirical findings show that sexuality education in Sweden has long been provided targeting school pupils. Most frequently taught subjects include factual information about growth and development, reproductive systems, empowerment through such skills as (refusal, negotiation of condom use, how to terminate a relationship etc), STIs including HIV and teenage pregnancy to mention but a few. It is teachers and school counsellors who discuss sexuality issues and often they would invite guests from youth clinics and other organisations such as RFSU i.e. the Swedish Association for sexuality education and The Swedish Federation for Lesbian, Gay, Bisexual and Transgender Rights (commonly known as RFSL in Swedish). RFSU is much more invited. The Swedish government has Adolescent Sexual Reproductive Health policies and has also established youth clinics which have qualified staff to deal with young people’s psychological, sexuality and other related problems. Finally, the report shows that some factors contribute to the rise in the number of STIs among youth in Sweden and it is the service providers’ desire to reverse this problem. Key words: adolescents, sexual reproductive health, sexuality education, STIs prevention, empowerment, self efficacy, 1 ACKNOWLEDGEMENTS It is with pleasure that I take this opportunity to acknowledge many people who have helped in this study. To my supervisor Barbro Lennéer Axelson (associate professor in psychology, Department of Social Work- Gothenburg University and the member of global board for IPPF) for her support, constructive guidance by showing confidence in me through words of encouragement. I remain ever thankful to my sponsors, The Adlebertska Fonderna. Without them I would have not been able to pursue this programme and let alone study in Sweden. I thank them for enriching my scholarship. To all staff in Social Work department, thank you for the wonderful time we had together. And not forgetting all the respondents for this study as well as my fieldwork supervisor, Charles Buyondo. The depth and breadth of this study could have not been achieved without their informative contributions. These were from Gamlestaden, Frölunda, Kållered, Centrum clinics and Hvitfeldtska Gymnasiet as well as Gothenburg’s Centre for Infectious Disease Control. To my family, especially to my husband, words can’t express my heart felt gratitude. I have managed because of you. You were there for me and our daughter when I most needed you. Your forbearance was great when it seemed there was no light at the end of the tunnel, but finally I saw it. 2 1. INTRODUCTION 1.1 The structure of the degree report This thesis sought to reflect on how sexuality education is conducted in Sweden. The report starts with the reason why I chose to write about this subject area, general overview of youth sexuality and HIV/AIDS, followed by background of sexual reproductive health education in Sweden, research aims and research questions, research on sexuality in Sweden, theoretical concepts and definition of words thereafter a presentation of my own research findings including results and analysis, reflections will be brought in linking findings to Sub Saharan African countries (with special reference to Botswana and Swaziland) and ending with recommendations. 1.2 Choice of subject I have decided to write about sexuality education in Sweden because Sub-Saharan Africa (the region I’m coming from) is more heavily affected by HIV/AIDS among youth than any other region of the world. I used Botswana and Swaziland as examples in this paper because they are among countries in this region hardest hit. The response to HIV/AIDS was expanded in many different directions to include education, prevention, treatment and care. I was working for one of the organisations called Botswana Christian AIDS Intervention Programme (BOCAIP) as a youth programme officer. It is churches’ initiative to mitigate the spread of HIV and dealing with its psychosocial effects among individuals, families and communities. It has a lot of programmes and among them was a youth programme which aims to contribute to the reduction of HIV/AIDS, STIs and teenage pregnancy amongst young people aged 12-29 in the south eastern part of the country. The age 12-29 years was adopted because it is an age bracket that defines a young person according to Botswana’s National Youth Policy. My interest is to acquire some of the health promotion skills as being used by professionals in Sweden, especially social workers in the area of youth & sexual health as I am also one. 1.3 Aims and objectives of the study The study aims at finding out the content of sexual reproductive health education in Sweden. This will include reflections on the type of information that young people access. Since Sweden has a relatively lower prevalence rate of HIV/AIDS and teenage pregnancies compared to other countries as per the international standards, the study will get to find out furthermore on how and where youth access to the needed information. 1.4 Research questions My research questions are as follows: 1. How is the sexual reproductive health information and education provided in Sweden? 2. What kind of topics are provided and by whom? 3. Youth clinics’ service providers and teachers’ work experiences concerning youth and sexual health 3 Words such as adolescent, sexual health, sexuality education and sexual rights have been defined in details under the theory chapter (i.e. chapter 4). 2. YOUTH & HEALTH – Some Facts 2.1 Youth Sexual Health and HIV/AIDS Change is taken as everyday part of life. It might be positive or negative depending on how people term it to be. In the past, such words as sexual desire, sexual well-being and sexuality in general were a taboo. Today people are freer to talk about sexual and reproductive health. In many countries there is also access to information; for example through mass media or other